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Related Experiment Videos

Leflunomide induced acute interstitial pneumonia.

Michio Takeishi1, Yuji Akiyama, Haruhiko Akiba

  • 1Division of Rheumatology, Saitama Medical School, Saitama, Japan. mtakeish@saitama-med.ac.jp

The Journal of Rheumatology
|June 9, 2005
PubMed
Summary

Leflunomide treatment for rheumatoid arthritis (RA) can cause interstitial pneumonia, a serious lung condition. Early detection and treatment with steroids and cholestyramine can improve patient outcomes.

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Area of Science:

  • Rheumatology
  • Pulmonology
  • Pharmacology

Background:

  • Rheumatoid arthritis (RA) is a chronic autoimmune disease often treated with disease-modifying antirheumatic drugs (DMARDs).
  • Leflunomide is an immunosuppressive DMARD used in RA management.
  • Interstitial pneumonia is a potential severe adverse effect associated with certain immunosuppressive therapies.

Observation:

  • A 54-year-old woman with RA developed acute respiratory failure two weeks after completing a six-week course of leflunomide.
  • The patient presented with elevated serum liver enzymes and hypertension preceding the respiratory failure.
  • These clinical signs suggest a potential drug-induced toxicity.

Findings:

  • Interstitial pneumonia was diagnosed and strongly suspected to be induced by leflunomide.

Related Experiment Videos

  • The patient experienced significant clinical improvement following treatment with prednisolone and cholestyramine.
  • Post-marketing surveillance data from Japan indicates leflunomide may initiate or worsen interstitial pneumonia in RA patients.

    • Implications:

    • Prompt diagnosis and intervention, including steroid and cholestyramine therapy, can lead to favorable outcomes in leflunomide-induced interstitial pneumonia.
    • Clinicians must perform thorough pre-treatment evaluations, including medical history, physical examination, and chest radiography, to exclude pulmonary disease before initiating leflunomide in RA patients.
    • This case highlights the importance of vigilance for rare but severe adverse drug reactions in rheumatological practice.